Intra-osseous plate system and method

ABSTRACT

An intra-osseous support structure can be used to fixate opposed portions of bone. In some examples, the intra-osseous support structure is positioned in openings formed in adjacent portions of bones. Fasteners are inserted through the bone portions to secure the intra-osseous support structure in the bones. Depending on the application, one or more external bone plates may also be applied to the bone portions. The external bone plate may be in compression while the intra-osseous support structure is in tension under load in situ.

RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.16/877,159, filed May 18, 2020, which is a continuation of U.S. patentapplication Ser. No. 15/148,774, filed May 6, 2016 and issued as U.S.Pat. No. 10,653,467, on May 19, 2020, which claims the benefit of U.S.Provisional Application Ser. No. 62/157,561, filed May 6, 2015. Theentire contents of each of these applications are incorporated herein byreference.

TECHNICAL FIELD

This disclosure relates generally to bone plate devices and methods forfixing bone using plate devices.

BACKGROUND

Bones, such as the bones of a foot, may be anatomically misaligned. Incertain circumstances, surgical intervention is required to correctlyalign the bones to reduce patient discomfort and improve patient qualityof life. Surgical intervention may involve cutting one or more of themisaligned bones and then physically realigning the bones into ananatomically corrected position. A bone plate or multiple bone platesmay be used to hold the bones in the anatomically corrected position,helping to prevent the bones from shifting back to their misalignedposition.

SUMMARY

In general, this disclosure is directed to bone fixation systems andtechniques for fixating bones. In some examples, a bone plating systemincludes an intra-osseous support structure configured to be placed inan opening formed between adjacent bones. For example, during atarsal-metatarsal fusion procedure in which a first metatarsal isrealigned with respect to a second metatarsal, the intra-osseous supportstructure may be placed within the osseous tissue of the firstmetatarsal and the medial cuneiform, spanning the tarsal-metatarsaljoint. An opening or groove may be formed in the end of the firstmetatarsal facing the medial cuneiform and also in the end of the medialcuneiform facing the first metatarsal, providing cavities in whichopposed ends of the intra-osseous support structure are inserted. One ormore fasteners can be used to secure the intra-osseous support structureto the bones in which the fastener is inserted. For instance, in theexample of a tarsal-metatarsal fusion procedure, a fastener may beinserted into the medial cuneiform (e.g., from the dorsal toward theplantar side), securing the intra-osseous support structure to themedial cuneiform. A second fastener can be inserted into the firstmetatarsal (e.g., from the dorsal toward the plantar side), securing theintra-osseous support structure to the first metatarsal.

In some applications, a bone plate is also applied on exterior surfacesof the bone portions into which the intra-osseous support structure isinserted. For example, one or more flat or curved bone plates may beapplied to exterior surfaces of bone portions containing theintra-osseous support structure. Depending on the configuration, theexterior bone plate(s) may be in compression while the intra-osseoussupport structure is in tensions under load, providing a balancedfixation system to effectively fixation opposed portions of bone.

In one example, a bone plating system is described that includes afastener having a length and an intra-osseous support structure. Theexample specifies that the intra-osseous support structure is configuredto be placed in an opening formed in a first bone portion and a secondbone portion and has an aperture to receive the fastener.

In another example, a method of plating a bone is described. The methodincludes forming an opening in a first bone portion and a second boneportion and placing an intra-osseous support structure in the opening.The method further includes inserting a first fastener through the firstbone portion and into the intra-osseous support structure and insertinga second fastener through the second bone portion and into theintra-osseous support structure.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a bone plating system in accordance withan embodiment of the invention.

FIG. 2 is a perspective view of a bone plating system in accordance withan embodiment of the invention.

FIG. 3 is a perspective view of a bone plating system in accordance withan embodiment of the invention.

FIG. 4 is a perspective view of a bone plating system in accordance withan embodiment of the invention, with bone portions depicted astransparent.

FIG. 5 is a top view of a bone plating system in accordance with anembodiment of the invention, with bone portions depicted as transparent.

FIG. 6 is a perspective view of a bone plating system in accordance withan embodiment of the invention, with bone portions depicted astransparent.

FIG. 7 is a perspective view of a bone plating system in accordance withan embodiment of the invention, with bone portions depicted astransparent.

FIG. 8 is a perspective view of a bone plating system in accordance withan embodiment of the invention, with bone portions depicted astransparent.

FIG. 9 is a side view of a bone plating system in accordance with anembodiment of the invention, with bone portions depicted as transparent.

FIG. 10 is an end view of a bone plating system in accordance with anembodiment of the invention, with bone portions depicted as transparent.

FIG. 11 is a side view of a bone plating system in accordance with anembodiment of the invention, with bone portions depicted as transparent.

FIG. 12 is an end view of a bone plating system in accordance with anembodiment of the invention, with bone portions depicted as transparent.

FIG. 13 is a top plan view of an intra-osseous support structure inaccordance with an embodiment of the invention.

FIG. 14 is a top plan view of an intra-osseous support structure inaccordance with an embodiment of the invention.

FIG. 15 is a perspective view of a bone plating system in accordancewith an embodiment of the invention, with bone portions depicted astransparent.

FIG. 16 is a perspective view of a bone plating system in accordancewith an embodiment of the invention, with bone portions depicted astransparent.

DETAILED DESCRIPTION

The following detailed description is exemplary in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description provides somepractical illustrations for implementing exemplary embodiments of thepresent invention. Examples of constructions, materials, dimensions, andmanufacturing processes are provided for selected elements, and allother elements employ that which is known to those of ordinary skill inthe field of the invention. Those skilled in the art will recognize thatmany of the noted examples have a variety of suitable alternatives.

Embodiments of the invention include a bone plating system. Embodimentsof the system can be useful for providing structural support to bonessubject to a surgical procedure, such as a bone alignment, osteotomy,fracture repair, and/or fusion procedure. Such a procedure may beperformed, for example, on bones (e.g., adjacent bones separated by ajoint or different portions of a single bone separated by a fracture) inthe foot or hand. In one example, the procedure can be performed tocorrect an alignment between a metatarsal (e.g., a first metatarsal) anda cuneiform (e.g., a first cuneiform), such as a bunion correction. Anexample of such a procedure is a lapidus procedure. In another example,the procedure can be performed by modifying an alignment of a metatarsal(e.g., a first metatarsal). An example of such a procedure is a basilarmetatarsal osteotomy procedure.

As shown in FIG. 1 , embodiments of the bone plating system 10 includean intra-osseous support structure 20. As shown, the intra-osseoussupport structure can be adapted to be positioned intra-osseously. Insuch embodiments, the intra-osseous support structure is positionedwithin a thickness of a bone, such that both of its major surfaces facebone (e.g., cancellous bone). In the embodiment shown, the intra-osseoussupport structure 20 is adapted to be positioned within an opening 30 ofa first bone portion 34 and a second bone portion 38, the openingleading to a cavity or void within the respective bone portions. Asshown, in a bone portion having a dorsal surface 40 and a plantarsurface 42, the opening can be formed closer to the plantar surface thanthe dorsal surface (e.g., between about one-half and two-thirds throughthe thickness of the bone). In certain embodiments, the opening crossesa centerline of one or both bone portions. In such embodiments, the bonedefining the opening, and the intra-osseous support structure placedtherein, will be in tension under load in situ. Such an intra-osseoussupport structure can be useful for providing structural support tobones subject to a surgical procedure.

The intra-osseous support structure 20 can include any useful form. Insome embodiments, the intra-osseous support structure has a first majorsurface, a second major surface, and a perimeter edge extending betweenthe first major surface and the second major surface. In the embodimentshown in FIG. 1 , the intra-osseous support structure is generallyplanar as are its first and second major surfaces. The major surfacescan be devoid of any protrusions. In certain embodiments, one or both ofthe major surfaces can include a surface treatment such as a texture. Insome embodiments (not shown), the intra-osseous support structure caninclude a portion generally perpendicular to a first major surface. Forexample, the intra-osseous support structure can include a portion thatextends from a side (e.g., a medial side) and bends or curves in anupward (e.g., dorsal) or a downward (e.g. plantar) direction aroundand/or in apposition to a cortical surface of a bone.

In the embodiment shown in FIG. 1 , the intra-osseous support structure20 is connected to a bone portion by at least one fastener 50. In someembodiments, the intra-osseous support structure has a first portion forplacement in the first bone portion 34 and a second portion forplacement in the second bone portion 38, and at least one aperture (notshown in FIG. 1 ) to receive a respective fastener can be provided oneach portion. In situ, the fastener can extend through a bone surface(e.g., a dorsal surface) and a portion of the thickness of a bone to theintra-osseously positioned support structure and be received into anaperture thereof

As shown in FIGS. 2 and 3 , some embodiments of the bone plating system10 can include a bone plate 60. In the embodiment shown, the plate isadapted to be positioned on an outer surface of the first bone portion34 and an outer surface of the second bone portion 38. As shown, in abone portion having a dorsal surface and a plantar surface, the dorsalsurface, and the plate placed thereon, will be in compression under loadin situ. Accordingly, some embodiments of the plating system include aplate in compression and an intra-osseous support structure in tensionunder load in situ. Such a plating system can be useful for providingstructural support to bones subject to a surgical procedure.

The bone plate 60 can include any suitable form. In some embodiments,the bone plate has a bone facing surface and a surface opposite the bonefacing surface. In certain embodiments, such as the embodiment shown inFIG. 2 , the bone plate 60 includes a generally planar member havinggenerally planar surfaces. In other embodiments, such as the embodimentshown in FIG. 3 , the bone plate 60 includes a curved shape (aboutand/or along its longitudinal axis). For example, the surface facing thebone can be concave and the opposite surface can be convex. In certainembodiments, the surface of the bone plate facing the bone may also haveat least one protrusion to engage with the surface of the bone.

In embodiments of the plating system having a plate 60, the plate andintra-osseous support structure 20 can be connected to the bone and eachother by the at least one fastener 50. In such embodiments, the boneplate 60 can have at least one aperture 64, 66 to receive respectivefasteners 50, 52. In the embodiment shown, the bone plate has a firstportion for placement on the first bone portion 34 and a second portionfor placement on the second bone portion 38. At least one aperture 64,66 for receiving a respective fastener 50, 52 can be provided on eachportion. Further, the intra-osseous support structure 20 can have atleast one aperture (not shown in FIGS. 2 and 3 ) aligned to receive therespective fastener. In situ, the fastener can extend through the boneplate, a surface of the bone, and a portion of the thickness of a boneto the intra-osseously positioned support structure and be received intothe aperture thereof. After final placement, in some embodiments, thebone plate and intra-osseous support structure will be generallyparallel to each other.

In some embodiments, the aperture in the intra-osseous support structurecan include an attachment mechanism configured to engage a fastener. Thefastener and attachment mechanism can include any structure suitable forengagement. In some embodiments, the fastener includes a screw, and theattachment mechanism includes a threaded aperture to receive and engagethe screw. The attachment mechanism can include guides to facilitatealignment with the fasteners. In some embodiments, the fastener has alength that is less than the thickness of the bone. In certainembodiments, the fastener will have a length between about one-half ofthe thickness of the bone and the entire thickness of the bone. Forexample, the fastener can have a length of about two-thirds thethickness of the bone. In some embodiments, the fastener can extendthrough the aperture of the intra-osseous support structure (optionallyengaging an attachment member thereof) and engage bone on one or bothsides of the intra-osseous support structure.

Any number of fasteners and respective intra-osseous support structureapertures can be provided. In the embodiment shown in FIGS. 1-3 , theintra-osseous support structure 20 includes two apertures to receive tworespective fasteners 50, 52. In the embodiment shown in FIGS. 4 and 5 ,the intra-osseous support structure 20 includes four apertures 70, 72,74, 76 to receive four respective fasteners 50, 52, 54, 56. In otherembodiments, the intra-osseous support structure includes threeapertures to receive three respective fasteners. In an embodiment of anintra-osseous support structure having a portion generally perpendicularto a first major surface, such a portion may include one or moreapertures for receiving a fastener.

The fasteners and respective apertures can be provided in anyorientation. In some embodiments, such as the embodiments shown in FIGS.4 , the apertures 70, 72, 74, 76 have a longitudinal axis perpendicularto a first major surface of the intra-osseous support structure 20. Inother embodiments, such as the embodiment shown in FIGS. 6 and 7 , theapertures 70, 72 have a longitudinal axis that intersects a first majorsurface of the intra-osseous support structure 20 at a skewed angle(e.g., an angle ranging from about 20 degrees to about 40 degrees fromperpendicular). Further, in some embodiments, fasteners 50, 52 canextend from the bone surface and through the bone generally parallel toeach other. In other embodiments, first and second fasteners can extendfrom the bone surface and through the bone at a skewed angle relative toeach other. In embodiments of the plating system that include a plate,apertures 64, 66 can be configured such that first and second fasteners50, 52 can extend from the bone plate 60 generally parallel to eachother or at a skewed angle relative to each other.

As shown in FIGS. 8-12 , some embodiments of the plating system caninclude an additional support that does not engage the intra-osseoussupport structure. Such an additional support can be useful forproviding rotational stability to the plated bone portions. In theembodiment shown in FIG. 8 , the additional support includes a staple100 having an end in each bone portion 34, 38. In the example shown inFIGS. 9-10 , the additional support includes a pin 110 extending acrossthe bone portions 34, 38 at an angle (e.g., about 45 degrees). In theembodiment shown, the pin 110 includes threads 120 on its distal portionto engage bone. It also includes notches 130 on its proximal portion.The pin can be broken at a desired notch after installation. In theembodiment shown in FIGS. 11 and 12 , two pins 110 are provided. Asshown, the pins are inserted such that they extend across the boneportions 34, 38 in a crossing pattern, each at an angle (e.g., about 45degrees).

The plating system can also include features useful for placing theintra-osseous support structure. As shown in FIG. 3 , the intra-osseoussupport structure 20 can include a stop 150 on the perimeter edge thatextends past the first major surface or the second major surface. Insome embodiments, the stop is on a medial side of the intra-osseoussupport structure. In other embodiments, as shown in FIG. 13-15 , a tab170 extending beyond the perimeter edge (e.g., on a medial side) can beprovided. The tab can be useful for placing the intra-osseous supportstructure within the bone, and, in some embodiments, can be providedwith break seam such that it can be easily removed from theintra-osseous support structure after placement. FIG. 16 shows inintra-osseous support structure 20 with the tab removed.

The plating system can be used to join any bone portions. In oneexample, the first bone portion and the second bone portion are portionsof a single bone separated by a fracture. As a further example, thefirst bone portion and the second bone portion are portions of a singlebone separated by an osteotomy. As another example, the first boneportion and the second bone portion can be portions of two differentbones separated by a joint, such as a cuneiform (e.g., medial cuneiform)and a metatarsal (e.g., first metatarsal). In the two-bone example, theintra-osseous support structure can be placed intra-osseously in thecuneiform and the metatarsal in an opening that spans the jointtherebetween (e.g., tarsal-metatarsal joint). In such an embodiment,fasteners having a length less than the thickness of the cuneiform andmetatarsal, respectively, can be used to connect the intra-osseoussupport structure to the bones. In embodiments of the plating systemhaving a bone plate, the bone facing surface of the bone plate can beplaced facing a dorsal surface of the cuneiform and a dorsal surface ofthe metatarsal, spanning a joint therebetween, and the fasteners canextend through apertures defined by the plate.

Embodiments of the invention also include methods of plating a bone,such as with the embodiments of bone plating systems described herein.Note the order of steps as described is only exemplary unless otherwiseindicated. In some embodiments, after preparing the surgical area, themethod can include the step of forming an opening in a first boneportion and a second bone portion. The opening can be formed from a sideof the bone. The opening can be formed generally parallel with alongitudinal axis of the bone, or may be formed at an angle with respectto such longitudinal axis such that it crosses the longitudinal axis.The opening can be formed, e.g., by a saw, drill, mill, box chisel,router, or the like.

The method can also include the steps of placing an intra-osseoussupport structure in the opening and aligning it in a desired position.In some embodiments, the intra-osseous support structure can be placedgenerally parallel to a longitudinal axis of the bone (e.g., toward atension side of the longitudinal axis. In other embodiments, theintra-osseous support structure can be placed at a skewed angle relativeto the longitudinal axis of the bone, such that it crosses thelongitudinal axis of the bone. In such embodiments, at least a portionof the intra-osseous support structure will reside on a tension side ofthe longitudinal axis and another portion will reside on a compressionside of the longitudinal axis. The method can also include the steps ofinserting a first fastener through a first bone portion and engaging thefirst fastener with the intra-osseous support structure, and inserting asecond fastener through a second bone portion and engaging the secondfastener with the intra-osseous support structure to secure the platingsystem to the bone. In some embodiments, the step of placing theintra-osseous support structure in the opening includes placing a stopin apposition to the first bone portion or the second bone portion. Inembodiments of intra-osseous support structures having tabs, the methodcan also include removing the tab after placement of the supportstructure. Embodiments of the method can also include attaching anadditional support structure to the first bone portion and the secondbone portion.

In some embodiments, the method can also include the step of forming afirst hole in the first bone portion from the first surface and towardan opposite surface and forming a second hole in the second bone portionfrom the second surface and toward an opposite surface. The first andsecond holes and the opening can intersect. The first and second holescan be formed, for example, with hand-driven or powered drills. In suchembodiments, the fasteners can be inserted through the holes to engagean intra-osseous support structure placed within the opening.

Embodiments of the method also include placing a bone plate having afirst portion in apposition to a first surface of a first bone portionand a second portion in apposition to a second surface of a second boneportion, the bone plate having a first aperture in the first portion anda second aperture in the second portion. The bone plate can be initiallyheld in position by pins and/or protrusions. The fasteners can beinserted through apertures defined by the plate.

Thus, embodiments of the invention are disclosed. Although the presentinvention has been described with reference to certain disclosedembodiments, the disclosed embodiments are presented for purposes ofillustration and not limitation, and other embodiments of the inventionare possible. One skilled in the art will appreciate that variouschanges, adaptations, and modifications may be made without departingfrom the spirit of the invention.

1. A method comprising: performing an osteotomy on a metatarsal toseparate the metatarsal into a first metatarsal portion and a secondmetatarsal portion; adjusting an alignment of the first metatarsalportion relative to the second metatarsal portion; placing a firstportion of an intra-osseous support structure in the first metatarsalportion; and connecting a second portion of the intra-osseous supportstructure to the second metatarsal portion using at least one fastener.2. The method of claim 1, wherein connecting the second portion of theintra-osseous support structure to the second metatarsal portioncomprises inserting a screw through an outer surface of the secondmetatarsal portion.
 3. The method of claim 2, further comprising forminga hole in the second metatarsal portion from the outer surface toward anopposite surface, wherein inserting the screw through the outer surfaceof the second metatarsal portion comprises inserting the screw into thehole.
 4. The method of claim 2, wherein the second portion of theintra-osseous support structure comprises a threaded aperture, andinserting the screw through the outer surface of the second metatarsalportion comprises inserting the screw into the threaded aperture.
 5. Themethod of claim 1, wherein connecting the second portion of theintra-osseous support structure to the second metatarsal portion usingat least one fastener comprises inserting the at least one fastenerthrough a thickness of the second metatarsal portion less than an entirethickness of the second metatarsal portion.
 6. The method of claim 5,wherein the thickness of the second metatarsal portion is within a rangefrom one-half to two-thirds of the entire thickness of the secondmetatarsal portion.
 7. The method of claim 1, further comprisinginserting a fastener into the first portion of the intra-osseous supportstructure.
 8. The method of claim 7, wherein inserting the fastener intothe first portion of the intra-osseous support structure comprisesinserting the fastener through an outer surface of the first metatarsalportion.
 9. The method of claim 8, wherein inserting the fastenerthrough the outer surface of the first metatarsal portion comprisesengaging the fastener with the intra-osseous support structure in thefirst metatarsal portion.
 10. The method of claim 7, wherein insertingthe fastener into the first portion of the intra-osseous supportstructure comprises inserting the fastener through a thickness of thefirst metatarsal portion less than an entire thickness of the firstmetatarsal portion.
 11. The method of claim 7, wherein the fastenercomprises a first fastener, and further comprising inserting a secondfastener into the first portion of the intra-osseous support structure.12. The method of claim 1, further comprising placing the second portionof the intra-osseous support structure in the second metatarsal portion.13. The method of claim 12, further comprising forming an opening in thesecond metatarsal portion, wherein placing the second portion of theintra-osseous support structure in the second metatarsal portioncomprises placing the second portion of the intra-osseous supportstructure in the opening in the second metatarsal portion.
 14. Themethod of claim 1, wherein placing the first portion of theintra-osseous support structure in the first metatarsal portion andconnecting the second portion of the intra-osseous support structure tothe second metatarsal portion comprises fusing the first metatarsalportion to the second metatarsal portion.
 15. The method of claim 1,further comprising forming an opening in the first metatarsal portion,wherein placing the first portion of the intra-osseous support structurein the first metatarsal portion comprises placing the first portion ofthe intra-osseous support structure in the opening in the firstmetatarsal portion.
 16. The method of claim 1, wherein the at least onefastener comprises two fasteners, and connecting the second portion ofthe intra-osseous support structure to the second metatarsal portionusing at least one fastener comprises connecting the second portion ofthe intra-osseous support structure to the second metatarsal portionusing two fasteners.
 17. The method of claim 1, wherein the metatarsalis a first metatarsal.
 18. A method comprising: performing an osteotomyon a metatarsal to separate the metatarsal into a first metatarsalportion and a second metatarsal portion; adjusting an alignment of thefirst metatarsal portion relative to the second metatarsal portion; andfixating the first metatarsal portion relative to the second metatarsalportion for fusion using a structure that includes a first portionconfigured to be positioned intra-osseously and a second portion thatincludes at least one aperture configured to receive a screw, whereinfixating the first metatarsal portion relative to the second metatarsalportion comprises inserting the first portion of the structure withinthe first metatarsal portion and screwing at least one screw into the atleast one aperture of the second portion of the structure and into thesecond metatarsal portion.
 19. The method of claim 18, wherein insertingthe first portion of the structure within the first metatarsal portioncomprises inserting the first portion of the structure within cancellousbone of the first metatarsal portion.
 20. The method of claim 18,wherein the at least one aperture comprises a threaded aperture, andscrewing at least one screw into the at least one aperture of the secondportion of the structure comprises screwing at least one screw into thethreaded aperture of the second portion of the structure.
 21. The methodof claim 18, wherein the at least one aperture comprises two aperturesand the at least one screw comprises two screws, and screwing at leastone screw into the at least one aperture of the second portion of thestructure and into the second metatarsal portion comprises screwing twoscrews into the two apertures of the second portion of the structure andinto the second metatarsal portion.
 22. The method of claim 18, whereinthe first portion comprises at least one aperture configured to receivea screw, and further comprising screwing at least one screw into the atleast one aperture of the first portion of the structure positionedwithin the first metatarsal portion.
 23. The method of claim 22, whereinthe first portion comprises two apertures, and screwing at least onescrew into the at least one aperture of the first portion of thestructure positioned within the first metatarsal portion comprisesscrewing a screw into each of the two apertures of the first portion ofthe structure positioned within the first metatarsal portion.
 24. Themethod of claim 18, wherein the metatarsal is a first metatarsal.